Names and pronunciation
(i-me-pen′em/sye-la-stat′in) Primaxin IM, Primaxin IV
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Drug reference
(i-me-pen′em/sye-la-stat′in) Primaxin IM, Primaxin IV
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Func. class.: Antiinfective— miscellaneous
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Chem. class.: Carbapenem
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ACTION: Interferes with cell-wall replication of susceptible organisms; osmotically unstable cell-wall swells, bursts from osmotic pressure; addition of cilastatin prevents renal inactivation that occurs with high urinary concentra- tions of imipenem
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USES: Serious infections caused by gram-positive Streptococcus pne umoniae, group A β-hemolytic strepto- cocci, aureus, Staphylococcus enterococcus; gram-negative Klebsiella, Proteus, Escherichia coli, Acinetobacter, Serratia, Pseudomonas aeruginosa, Sal monella, Shigella, Haemophilus influen zae, Listeria sp.; lower respiratory tract infections, UTIs, septicemia, endocarditis, bone/joint infections, skin structure infec- tions
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CONTRAINDICATIONS: Hyper- sensitivity to this product, amide local anesthetics, or carbapenems; AV block, shock (IM), breastfeeding Precautions: Pregnancy, breastfeeding, children, geriatric patients, seizure dis- orders, renal disease, head trauma; hypersensitivity to cephalosporins, peni- cillins; CDAD, ulcerative colitis, diabetes mellitus
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SIDE EFFECTS CNS: Fever, somnolence, seizures, con- fusion, dizziness, weakness, myoclonus, drowsiness CV: Hypotension, palpitations, tachy- cardia GI: Diarrhea, nausea, vomiting, CDAD, hepatitis, glossitis, gastroenteritis, abdominal pain, jaundice HEMA: Eosinophilia INTEG: Rash, urticaria, pruritus, pain at inj site, phlebitis, erythema at inj site, erythema multiforme, Stevens-Johnson syndrome, toxic epidermal necrolysis, angioedema EENT: Hearing loss, tinnitus SYST: Anaphylaxis, electrolyte abnor malities
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INTERACTIONS Increase: imipenem plasma levels— probenecid Increase: antagonistic effect—β-lactam antibiotics Increase: seizure risk—ganciclovir, the- ophylline, aminophylline, cycloSPORINE Decrease: effect of valproic acid Decrease: effect aminoglycosides if admixed Drug/Lab Test Increase: AST, ALT, LDH, BUN, alk phos, bilirubin, creatinine, potassium, chloride Decrease: sodium False positive: direct Coombs’ test
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DOSAGE AND ROUTES Doses based on imipenem content are to be used IV infusion only Most infections • Adult IV 500–1000 mg every 6-8 hours depending on indication and or- ganism susceptibility; max 4 g/day. • Adolescent/child/infant ≥3 mo: IV 15-25 mg/kg every 6 hr • Infant 1-3 mo and ≥1500 g: IV 25 mg/ kg every 6 hr • Neonate 1-4 wk and ≥1500 g: IV 25 mg/kg every 8 hr • Neonate <7 days and ≥1500 g: IV 25 mg/kg every 12 hr Renal dose • Adult: CCr 60-89 mL/min: adjust to 400 mg every 6 hr for starting dose of 500 mg every 6 hr, to 500 mg every 6 hr for starting dose of 1 g every 8 hr, to 750 mg every 8 hr for starting dose of 1 g every 6 hr CCr 30-59 mL/min: adjust to 300 mg every 6 hr for starting dose of 500 mg every 6 hr, to 500 mg every 8 hr for start ing dose of 1 g every 8 hr, to 500 mg every 6 hr for starting dose of 1 g every 6 hr CCr 15-29 mL/min: adjust to 200 mg every 6 hr for starting dose of 500 mg every 6 hr, to 500 mg every 12 hr for starting dose of 1 g every 6 or 8 hr CCr <15 mL/min: Do not use unless hemodialysis is instituted within 48 hr
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Available forms: Powder for sol inj 250, 500 mg
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Administer: • After C&S is taken, may start treatment before results are received Intermittent IV infusion route • After reconstitution of 250 or 500 mg with 10 mL of diluent and shake, add to ≥100 mL of same infusion sol • 250-500 mg over 20-30 min; ≥750 mg over 40-60 min; give through Y-tube or 3-way stopcock; do not give by IV bolus or if cloudy, do not admix with other an- tibiotics separate by ≥1 hr (aminoglyco- sides) Y-site compatibilities: Acyclovir, alfent- anil, amifostine, amikacin, aminoca- proic acid, anidulafungin, argatroban, ascorbic acid, atenolol, atracurium, atropine, benztropine, bivalirudin, bleo- mycin, bumetanide, buprenorphine, butorphanol, CARBOplatin, carmustine, caspofungin, ceFAZolin, cefotaxime, cefoTEtan, cefOXitin, cefTAZidime, cefu- roxime, chloramphenicol, cimetidine, cisatracurium, CISplatin, clindamycin, codeine, cyanocobalamin, cyclophos- phamide, cycloSPORINE, cytarabine, DACTINomycin, dexamethasone, dexra- zoxane, digoxin, diltiaZEM, diphenhydr- AMINE, DOCEtaxel, dolasetron, DOPa- mine, doxacurium, DOXOrubicin, DOXOrubicin liposomal, doxycycline, enalaprilat, famotidine, fludarabine, foscarnet, granisetron, IDArubicin, insulin (regular), melphalan, metho- trexate, ondansetron, propofol, remi- fentanil, tacrolimus, teniposide, thio- tepa, vinorelbine, zidovudine
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Assess: • Renal studies: creatinine/BUN, electro- lytes • Seizures: product decreases seizure threshold and may decrease effective ness of seizure medications; monitor closely • Infection: increased temperature, WBC, characteristics of wounds, sputum, urine or stool culture • Sensitivity to penicillin, other β- lactams—may have sensitivity to this product • Renal disease: lower dose may be re- quired • CDAD: Bowel pattern daily; if severe diar rhea occurs, product should be discontinued; may indicate CDAD • Allergic reactions, anaphylaxis: rash, urticaria, pruritus, wheezing, laryngeal edema; may occur a few days after ther apy begins; have EPINEPHrine, antihista mine, emergency equipment available • Overgrowth of infection: perineal itching, fever, malaise, redness, pain, swelling, drain- age, rash, diarrhea, change in cough, sputum • Pregnancy/breastfeeding: use only if benefit outweighs fetal risk; use caution in breastfeeding, excretion unknown
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Evaluate: • Therapeutic response: negative C&S; ab- sence of signs and symptoms of infection
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: • To report severe diarrhea; may indicate CDAD I TREATMENT OF ANAPHY LAXIS: EPINEPHrine, antihistamines; resuscitate if needed
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PHARMACOKINETICS IV: Onset immediate, peak 20 min-1 hr; duration 6-8 hr 70%-80% excreted unchanged in urine
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• Adult IV 500–1000 mg every 6-8 hours depending on indication and or- ganism susceptibility; max 4 g/day.
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• Adolescent/child/infant ≥3 mo: IV 15-25 mg/kg every 6 hr
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• Infant 1-3 mo and ≥1500 g: IV 25 mg/ kg every 6 hr
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• Neonate 1-4 wk and ≥1500 g: IV 25 mg/kg every 8 hr
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• Neonate <7 days and ≥1500 g: IV 25 mg/kg every 12 hr Renal dose
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• Adult: CCr 60-89 mL/min: adjust to 400 mg every 6 hr for starting dose of 500 mg every 6 hr, to 500 mg every 6 hr for starting dose of 1 g every 8 hr, to 750 mg every 8 hr for starting dose of 1 g every 6 hr CCr 30-59 mL/min: adjust to 300 mg every 6 hr for starting dose of 500 mg every 6 hr, to 500 mg every 8 hr for start ing dose of 1 g every 8 hr, to 500 mg every 6 hr for starting dose of 1 g every 6 hr CCr 15-29 mL/min: adjust to 200 mg every 6 hr for starting dose of 500 mg every 6 hr, to 500 mg every 12 hr for starting dose of 1 g every 6 or 8 hr CCr <15 mL/min: Do not use unless hemodialysis is instituted within 48 hr
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